Fax +41 61 306 12 34 E-Mail karger@karger.ch www.karger.com Case Report Med Princ Pract 2010;19:232–234 DOI: 10.1159/000285300 A Rare Cause of Small Bowel Transection: Metastatic Lung Cancer Mehmet Yildirim a Funda Tasli b M. Emrah Bayam a Hakan Postaci b Departments of a Surgery and b Pathology, Izmir Bozyaka Teaching and Research Hospital, Izmir, Turkey of initial diagnosis. The most commonly involved organs are brain, bone, liver, adrenal glands and gastrointestinal tract. Small bowel involvement often leads to perforation, obstruction or bleeding [2, 3]. Perforations of the small bowel are most often caused by adenocarcinoma; how- ever, metastases from squamous cell and large cell carci- noma are more likely to result in perforation. Symptom- atic small bowel metastases from lung carcinoma have rarely been reported [4] . To our knowledge, this is the first case of circumferential small bowel transection due to metastasis. Case Report A 78-year-old male patient who had been diagnosed with lung cancer 3 months earlier presented to our clinic with acute abdom- inal pain. Prior to hospital admission, he complained of a 1-week history of abdominal pain. He had been evaluated at an oncology hospital, where he had been diagnosed with a 4-cm tumoral mass located in the posterior segment of the left lung. A computed to- mography scan of the thorax showed a primary pulmonary tumor invading the pleura, adjacent costa, and multiple enlarged hilar lymph nodes. He underwent a fine-needle biopsy, which disclosed non-small cell lung cancer. Based upon these pathologic and ra- diologic findings, the patient was considered inoperable. He was treated with a total of 6,600 cGy in 33 sessions of radiotherapy. Physical examination revealed an afebrile, ill-appearing pa- tient, with a heart rate of 110 bpm, a respiratory rate of 28 breaths/ min and a blood pressure of 100/70 mm Hg. The examination also showed a diffuse abdominal defense and rebound tenderness. Laboratory analyses were within normal limits except for leuko- Key Words Lung  Small bowel perforation  Metastasis Abstract Objective: To present a case of small bowel perforation due to metastatic lung cancer. Case Presentation and Interven- tion: A 78-year-old male patient, who had been diagnosed with lung cancer 3 months earlier, presented to our clinic with acute abdominal pain. He underwent emergency lapa- rotomy. At surgery, there was a circumferential lesion en- compassing the ileum with complete transection. There was no obvious macroscopic appearance of metastatic disease. The involved bowel segment was resected and an ileostomy was performed. Postoperative pathologic analysis con- firmed metastatic squamous cell carcinoma metastasis to the ileum, arising from the patient’s lung cancer. Conclu- sion: This case report showed that small bowel metastases should always be considered in the differential diagnosis of lung cancer patients presenting with acute abdominal pain. Copyright © 2010 S. Karger AG, Basel Introduction Lung cancer is a leading cause of cancer-related death throughout the world [1]. Approximately one half of pa- tients with lung cancer have metastatic disease at the time Received: January 20, 2009 Revised: July 7, 2009 Dr. Mehmet Yildirim Atakent Mah. Bergama 2 Apt. Giris:32 Daire:1 TR–35000 Bostanlı/Izmir (Turkey) Tel. +90 232 362 5692, Fax +90 232 261 4444 E-Mail mehmetyildi @ gmail.com © 2010 S. Karger AG, Basel 1011–7571/10/0193–0232$26.00/0 Accessible online at: www.karger.com/mpp